title: Surgical prevention of arm lymphedema after breast cancer treatment.
abstract: OBJECTIVE
  To prospectively assess the efficacy of the lymphatic microsurgical preventive healing approach (LYMPHA) to prevent lymphedema after axillary dissection (AD) for breast cancer treatment.
  
  
  METHODS
  Among 49 consecutive women referred from March 2008 to September 2009 to undergo complete AD, 46 were randomly divided in 2 groups. Twenty-three underwent the LYMPHA technique for the prevention of arm lymphedema. The other 23 patients had no preventive surgical approach (control group). The LYMPHA procedure consisted of performing lymphatic-venous anastomoses (LVA) at the time of AD. All patients underwent preoperative lymphoscintigraphy (LS). Patients were followed up clinically at 1, 3, 6, 12, and 18 months by volumetry. Postoperatively, LS was performed after 18 months in 41 patients (21 treatment group and 20 control group). Arm volume and LS alterations were assessed.
  
  
  RESULTS
  Lymphedema appeared in 1 patient in the treatment group 6 months after surgery (4.34%). In the control group, lymphedema occurred in 7 patients (30.43%). No statistically significant differences in the arm volume were observed in the treatment group during follow-up, while the arm volume in the control group showed a significant increase after 1, 3, and 6 months from operation. There was significant difference between the 2 groups in the volume changes with respect to baseline after 1, 3, 6, 12, and 18 months after surgery (every timing P value < 0.01).
  
  
  CONCLUSIONS
  LYMPHA represents a valid technique for primary prevention of secondary arm lymphedema with no risk of leaving undetected malignant disease in the axilla.
authors.affiliation: Department of Surgery, Unit of Lymphatic Surgery, S. Martino Hospital, University of Genoa, Genoa, Italy. francesco.boccardo@unige.it
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Boccardo
authors.forename: Federico
authors.initials: F
authors.lastname: Casabona
authors.forename: Daniele
authors.initials: D
authors.lastname: Friedman
authors.forename: Maria
authors.initials: M
authors.lastname: Puglisi
authors.forename: Franco
authors.initials: F
authors.lastname: De Cian
authors.forename: Filippo
authors.initials: F
authors.lastname: Ansaldi
authors.forename: Corradino
authors.initials: C
authors.lastname: Campisi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery; D061305:Lymphoscintigraphy; D008866:Microsurgery; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate